EVIDENCE FOR ABNORMAL CALCIUM HOMEOSTASIS IN PATIENTS WITH ADYNAMIC BONE-DISEASE
EVIDENCE FOR ABNORMAL CALCIUM HOMEOSTASIS IN PATIENTS WITH ADYNAMIC BONE-DISEASE
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DOI：
10.1038/ki.1994.342
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发表时间：
1994-09-01
影响因子：
19.6
通讯作者：
MALLUCHE, HH
中科院分区：
文献类型：
--
作者：
KURZ, P;MONIERFAUGERE, MC;MALLUCHE, HH
为了研究肾性骨营养不良患者的钙动力学紊乱在这种代谢性骨病的各种组织学形式中是否相似，对43名长期维持透析患者进行了双同位素技术的钙动力学研究、髂嵴骨活检以进行矿化骨组织学和组织形态计量学以及钙和骨代谢的血清指标测定。三个组织学组之间的肠道钙吸收没有差异。然而，女性在每种组织学形式中的钙吸收率均较低（P < 0.01）。甲状旁腺功能亢进性骨病患者的血浆钙流出、钙沉积率和钙保留明显高于正常值。患有低周转骨病的患者表现出正常或轻微降低的血浆钙流出和钙沉积率以及不成比例的低钙保留。混合性尿毒症骨营养不良患者的钙动力学特征介于其他两种类型之间。血浆钙流出、钙沉积率、钙保留和骨转换的组织形态学参数以及血清甲状旁腺激素水平之间存在良好的关系。然而，没有血清参数可以确定地表明潜在的骨疾病。这些发现表明，动力性骨病不仅代表了学术发现，而且其特征是缓冲钙的骨能力非常低并且无法处理额外的钙负荷。这对于目前接受比以往更高量的维生素 D 和钙盐的终末期肾衰竭患者的日常护理尤其重要。
To investigate whether the derangements in calcium kinetics in patients with renal osteodystrophy are similar in the various histologic forms of this metabolic bone disease, 43 patients on chronic maintenance dialysis underwent calcium kinetic studies using the double isotope technique, iliac crest bone biopsies for mineralized bone histology and histomorphometry and determinations of serum indices of calcium and bone metabolism. Intestinal calcium absorption was not different among the three histologic groups. However, women exhibited lower calcium absorption in each histologic form (P < 0.01). Patients with predominant hyperparathyroid bone disease showed plasma calcium efflux, calcium accretion rate and calcium retention markedly above normal values. Patients with low turnover bone disease exhibited a normal or slightly decreased plasma calcium efflux and calcium accretion rate together with a disproportionately low calcium retention. Patients with mixed uremic osteodystrophy presented with a calcium kinetic profile intermediary to the two other forms. Good relationships existed between plasma calcium efflux, calcium accretion rate, calcium retention and histomorphometric parameters of bone turnover as well as serum levels of parathyroid hormone. However, no serum parameter could indicate with certainty the underlying bone disease. These findings demonstrate that adynamic bone disease does not merely represent an academic finding but is characterized by a very low bone capacity to buffer calcium and inability to handle an extra calcium load. This is particularly relevant for the daily care of end-stage renal failure patients presently receiving higher than ever amounts of vitamin D and calcium salts.